Evaluating Intensive Care Nurses' Knowledge of Incontinence-Associated Dermatitis: A Multicenter Cross-sectional Study.

OBJECTIVE: To determine the knowledge levels of nurses working in the ICU about incontinence-associated dermatitis (IAD). METHODS: A descriptive cross-sectional study was conducted in adult ICUs at two private and three public hospitals in a province in Turkey. The study included 296 nurses who agreed to participate in the research. Researchers used the "Nurse Identification Form" and the "IAD Knowledge Test" to collect data on nurses' IAD knowledge. Data analysis included the use of percentage distribution and the Mann-Whitney U, Kruskal-Wallis, and Spearman correlation tests. RESULTS: The mean age of the nurses was 26.55 ± 3.89 years (range, 20-47 years), and the duration of working in the ICU was 2.71 ± 2.55 years (range, 1-22 years). Of the nurses, 183 (61.8%) worked in general ICUs. Of those, 69 (23.3%) received IAD training. Nurses achieved a 49.8% correct response rate on the IAD knowledge test. Nurses working in tertiary and general ICUs demonstrated higher IAD knowledge levels (Ps = .003 and .047, respectively). There were no relationships between age, career length, institution, ICU type, and IAD knowledge level. CONCLUSIONS: Nurses' knowledge level of IAD was low in intensive care. To remedy this, IAD should be added to intensive care nursing certificate programs as content, and the use of IAD risk assessment and diagnosis scales in ICUs should be expanded.

Care Needs of Older Adults With Urinary Incontinence: A Cross-Sectional Study.

PURPOSE: To explore care requirements of older adults with urinary incontinence (UI) and contributing factors. METHOD: This cross-sectional study used the Older Adults Urinary Incontinence Care Needs Inventory to survey participants with UI in three large-scale tertiary hospitals located in Guangzhou City, China, from January 2023 to November 2023. Statistical analyses, including analysis of variance, t tests, correlation analyses, and linear regression models, were conducted to assess factors influencing participants' care needs. RESULTS: A total of 530 older adults with UI participated in the survey and mean standardized score for overall care needs was 78.65 (SD = 5.01), with mean scores for each dimension ranging from 70.88 (SD = 10.55) for social participation needs to 82.45 (SD = 7.11) for health education needs. Factors that were found to influence incontinence care needs in older adults included age, literacy level, number of leaks, and type of disease (F = 37.07, adjusted R2 = 0.290, p < 0.001). CONCLUSION: Comprehensive care for older adults with UI, encompassing physiological, psychological, and social aspects, is crucial. It is essential to tailor care to individual needs and characteristics, taking into account factors, such as age and education, to ensure effective care. [Journal of Gerontological Nursing, 50(5), 43-49.].

Guidance for the provision of absorbent products for adult incontinence.

The Association for Continence Professionals first published their guidance for the provision of absorbent products for adult incontinence in 2017. This consensus document is targeted towards commissioning leads, NHS Trust Boards, Bladder and Bowel leads, among others, and has been updated over the years to ensure that all adults who suffer with continence issues undergo a comprehensive assessment and have access to an equitable service. This article provides an overview of the latest guidelines which were published in February 2023.

Penile urinary sheaths: a continence management system for men.

Urinary leakage is prevalent in men. To contain and manage this leakage, men are often advised about urinary devices. However, sometimes this advice does not include penile sheaths. Penile sheaths are a good way of managing urinary leakage if an individual is suitable for sheaths. This article will explore this suitability, advantages to using a sheath, reasons why sheaths may not be suitable, and will discuss optimum fitting to ensure the sheath is a secure drainage device.

The Value of Nurses Specialized in Wound, Ostomy, and Continence: A Systematic Review.

OBJECTIVE: To critically appraise peer-reviewed evidence concerning the value, or implied sense of worth or benefit, of nurses specialized in wound, ostomy, and continence (WOC) care. DATA SOURCES: The Preferred Reporting Items for Systematic Reviews and Meta-analyses was used to systematically review current literature in a single database from 2009 to the date of search (July 2019). STUDY SELECTION: The initial search retrieved 2,340 elements; 10 studies were retained following removal of duplicate records, title and abstract reviews, and application of the inclusion/exclusion criteria. DATA EXTRACTION: Literature was graded and critiqued with regard to design and research quality and then synthesized using a narrative approach. DATA SYNTHESIS: Nine values that WOC nurses demonstrate were identified: improved quality of life for patients, teaching and mentoring, cost reduction, improved efficiency, improved wound outcomes, improved incontinence outcomes, advanced treatments, research, and leadership. CONCLUSIONS: Although current studies suggest that there is value in the WOC nurse role, in all areas of the trispecialty, there is a need for high-quality literature with higher-level designs focused on bias reduction.

Urinary incontinence in stroke survivors - Development of a programme theory.

AIMS AND OBJECTIVES: To develop, in an inpatient rehabilitation setting, a programme theory that promotes continence in people who have suffered a stroke. BACKGROUND: Urinary incontinence in stroke survivors impacts the quality of life, rehabilitation outcomes and ultimately incurred costs of the patient. Different approaches are available for developing and testing complex interventions. DESIGN: Building a research-based programme theory. METHODS: To elaborate the intervention, a guidance for developing a complex intervention for nursing was chosen and the sources that should be considered were defined. Subsequently, a research-based programme theory was generated that was represented via a theoretical approach logic model. This study was guided by the checklist for reporting theory of change in public health interventions. RESULTS: The intervention consists of six parts with three outcome chains on interconnected levels, which are oriented towards patients and nurses. The important aspects of the programme theory are communication, individually tailored measures and the definition of interdisciplinary objectives. CONCLUSION: Developing a programme theory and representing it via a logic model help clarify the initial intervention and ensure that implementation strategies are well thought out. RELEVANCE TO CLINICAL PRACTICE: By employing detailed reflection and using previous research, it is expected that the intervention can be implemented successfully and its effectiveness can be investigated in more depth.

Development and randomised controlled trial of a Continence Product Patient Decision Aid for men postradical prostatectomy.

AIMS AND OBJECTIVES: To develop and evaluate an evidence-based Continence Product Patient Decision Aid (CP-PDA) to reduce decisional conflict and support continence product choice for men postradical prostatectomy. BACKGROUND: In 2018, 1.3 million men globally were diagnosed with prostate cancer. A common treatment is radical prostatectomy, usually leading to sudden onset of urinary incontinence. For people experiencing incontinence, products to contain leakage are fundamental to health-related quality of life, but many product users and healthcare professionals are unaware of available options. No evidence-based guidance on choosing products exists despite known physical and psychological burdens of poorly managed leakage (e.g. isolation, anxiety, depression, skin damage). DESIGN AND METHODS: 4 phases, underpinned by international decision aid guidance. Evidence/expert opinion: Literature review; consultation with specialist continence clinicians (n = 7) to establish evidence base. Prototype: CP-PDA developed with continence specialist (n = 7) feedback. Alpha testing (stakeholders): CP-PDA materials were provided to expert patients (n = 10) and clinicians (n = 11) to assess content/presentation. Beta testing (field) following CONSORT guidelines, registered NIHR CPMS 31077: Men (n = 50) postradical prostatectomy randomised to evaluate usability and decision-making using the Decisional Conflict Scale compared with usual care. RESULTS: An algorithm differentiating patients by mobility, dependency, cognitive impairment and type/level of leakage, leading to 12 user groups, was developed. For each group, an option table and associated product information sheets guide product choice. Total Decisional Conflict Score for men using the CP-PDA was significantly better than for men without. CP-PDA users reported greater confidence in product knowledge and choice. CONCLUSION: This is the first evidence-based CP-PDA, developed using an internationally recognised method. Compared to usual care, it significantly reduced decisional conflict for men choosing continence products postprostatectomy. RELEVANCE TO CLINICAL PRACTICE: The CP-PDA provides nurses with the first comprehensive, evidence-based intervention to help postprostatectomy men in complex continence product choices. An online version is available: www.continenceproductadvisor.org.

The Prevalence of Incontinence-Associated Dermatitis in Hospitalized Patients in China: A Systematic Review and Meta-Analysis.

OBJECTIVE: To determine the prevalence and characteristics of incontinence-associated dermatitis (IAD) among hospitalized Chinese patients. DATA SOURCES: Authors searched Chinese (China National Knowledge Infrastructure, Wanfang Data, VIP Data, Chinese Biomedicine) and English (PubMed, Web of Science) electronic databases for articles published from 1987 through February 2019. STUDY SELECTION: The preliminary search identified 558 studies. After removal of duplicates (n = 202), application of exclusion criteria, and screening titles and abstracts (n = 346), 10 studies met the inclusion criteria. DATA EXTRACTION: A standardized form was constructed to extract data from eligible studies, and this information was extracted by two independent authors. DATA SYNTHESIS: A pooled analysis of the 10 studies (total sample size, 40,039) showed the prevalence of IAD in hospitalized Chinese patients was 1.44% (95% confidence interval, 1.10%-1.79%). Subgroup analysis indicated no significant association between sex and IAD. Patients older than 90 years had the highest incidence of IAD (8.64%). The most common type was mild IAD (1.00%). Fecal incontinence (48.02%) led to more cases of IAD than urinary incontinence (11.35%) or both (25.78%). The most common types of IAD were perineal (0.92%) and perianal (0.90%). CONCLUSIONS: Incontinence-associated dermatitis is a global health problem that requires more attention. Understanding the prevalence and characteristics of IAD is helpful in the formulation of IAD prevention and treatment programs in China.

Efficacy of Incontinence-Associated Dermatitis Intervention for Patients in Intensive Care: An Open-Label Pilot Randomized Controlled Trial.

OBJECTIVE: To determine the feasibility of an adequately powered trial testing a long-acting cyanoacrylate skin protectant to prevent incontinence-associated dermatitis in critically ill patients. METHODS: This open-label pilot randomized controlled feasibility study was conducted in the adult ICU of an Australian quaternary referral hospital. Patients were allocated to either an intervention group or a control group (usual care). The intervention was the application of a skin protectant (a durable, ultra-thin, transparent, waterproof, no-removal barrier film). Data collected by trained research nurses included demographic and clinical variables, skin assessment, and incontinence-associated dermatitis presence and severity. Data were analyzed using descriptive and inferential statistics. RESULTS: Of the 799 patients screened, 85% were eliminated because of a short ICU stay or other exclusion criteria. The mean proportion of patients not meeting any of the exclusion criteria was 22% on each screening day. Protocol fidelity was followed for 90% of intervention participant study days. Retention of participants was 86% (31 participants out of 36), 15 in the intervention group and 16 in the control group. Enrolled patients had a mean age of 59 years, 50% were obese, 67% were male, and 36% were smokers. Two patients (11%) in the intervention group developed incontinence-associated dermatitis, compared with three (17%) in the control group. CONCLUSIONS: This study reports no significant findings between the two groups. Difficulty in recruitment and feasibility issues might be overcome with changes to inclusion criteria and study design.

The Effects of Education About Urinary Incontinence on Nurses' and Nursing Assistants' Knowledge, Attitudes, Continence Care Practices, and Patient Outcomes: A Systematic Review.

The aims of this systematic review were to describe, critique, and summarize research about the effects of education about urinary incontinence on nurses' and nursing assistants' knowledge and attitudes toward urinary incontinence, their continence care practices, and patient outcomes. We searched key electronic databases (PsycINFO, MEDLINE, CINAHL, Web of Science, and Cochrane Library) for full-text primary research articles written in the English language and published between January 1990 and October 2018. Studies were included if they described a controlled or uncontrolled trial of an education program for nurses or nursing assistants about urinary incontinence and evaluated the effects of the program on either knowledge, attitudes, practice, or patient outcomes. Data were extracted about the aim, design, sample and setting, trial methods, intervention, outcomes of interest, and findings. Quality appraisal was conducted using a mixed-methods appraisal tool. Results are presented in tabular format and reported descriptively. Nineteen studies met inclusion criteria; most were set in the United States or the UK. All trials that evaluated the effects on knowledge reported improvements; however, the effects of education on attitudes were mixed as were the effects of education on continence care practices. Eleven of the 19 studies reported the statistical effect of education on patient outcomes. Uncontrolled trials reported improvements in nursing home residents' and community-dwelling patients' continence status, but this effect was not observed in a large controlled trial. Similarly, 2 studies set in inpatient rehabilitation found no significant differences in patient continence outcomes following an educational intervention targeted to nurses.

[Using Teamwork to Reduce the Incidence of Incontinence-Associated Dermatitis].

BACKGROUND & PROBLEMS: Dermatitis associated with incontinence was the cause of 55% of the total of 386 skin lesion cases in our unit between July and December 2016 and 40.3% of the skin lesion cases in our unit during March and April 2017, indicating the importance of this issue. Our survey showed that the nurses in our unit scored an average of 78.9% on knowledge related to the prevention of incontinence-associated dermatitis and only 58.2% on knowledge related to incontinence-associated dermatitis care. The main reasons for the high incidence of incontinence-associated dermatitis included: incorrect implementation of care, no discussion with the medical team, no incontinence care standards, no continue education, lack of related equipment for preventing incontinence-associated dermatitis, unit patient characteristics, and drugs used. PURPOSE: To reduce the incidence of incontinence-associated dermatitis from 40.3% to 32.0%. RESOLUTION: A care-bundle in treating incontinence-associated dermatitis was implemented by designing an assessment flow chart for evaluating incontinence-associated dermatitis, by setting standard guidelines for incontinence-associated dermatitis care, by distributing reminder cards, special toolboxes, and by changing how the little diapers were wrapped. In-service education lessons, inter-professional collaborative practice, and regular internal audit were also executed. RESULTS: After project implementation, the knowledge score of nurses increased from 78.9% to 95.7%; the correctness of care score, as retested in November 2017, increased from 58.2% to 91.5%; and the incidence of incontinence-associated dermatitis dropped to 18.5%. These improvements achieved the goals of this project. Furthermore, the sustained effect of the project measures was confirmed, with the incidence of incontinence-associated dermatitis determined as 17.9% at three months after completion of the project. CONCLUSIONS: Formulating care procedures and cooperating with medical team personnel to provide creative care measures were shown to effectively decrease the incidence of incontinence-associated dermatitis and improve overall quality of care. The findings of this project support the revision by hospitals of regulations and procedures related to adult incontinence-associated dermatitis to provide caregivers with basis-of-care standards and uniform care procedures and standards in support of effective patient skin care regimens.

Prompted Voiding for Individuals With Urinary Incontinence.

Urinary incontinence (UI) is one of the most common conditions among residents of post-acute and long-term care facilities. UI is seen in at least 55% of nursing home residents and is the second leading cause of institutionalization of older adults. UI has been shown to be an independent risk factor for unplanned hospitalization of home care individuals. Prompted voiding (PV) is a toileting program that combines scheduled voiding with "prompting" from a caregiver and is appropriate for older adults with all types of UI and in individuals who may have impaired cognitive function. The current article summarizes a guideline on the evidence for PV in individuals with UI in reducing the frequency and severity of UI episodes, increasing self-initiated requests to toilet, and preventing complications associated with UI in older adults in their homes and acute and extended care facilities. [Journal of Gerontological Nursing, 45(2), 14-26.].

Quality of care to nursing home residents with incontinence.

Quality of care for residents with urinary incontinence (UI) living in nursing facilities was analyzed using data collected from 815 facilities for the Nursing Facility Quality Review in Texas. Overall, of the 1,560 residents, 48.4% (n = 755) experienced UI. The risk of developing UI over a ten-year-period in a nursing facility was 6%. Only 54% of residents with UI had a care plan for their incontinence. For those with a UI plan in their chart, 143 (35%) had a person entered UI plan developed based on that resident's voiding pattern and needs. Further, the creation of a UI plan of care by a RN for a person with UI was associated with a higher perceived level of health after controlling for gender, and age. Finally, the more satisfied the resident was with the response to their calls for help with voiding the more satisfied with the nursing facility.

Incontinence affects every aspect and stakeholder of an assisted living community.

A total incontinence management program will benefit a community's administration, nurses, caregivers, families and most importantly, residents. An incontinence program helps reduce the risk of incidences such as agitation, urinary tract infection, falls and skin complications which assisted living and memory care communities are trying to prevent. The correct evaluation tools increase the likelihood of successful outcomes because the program has to be the right program for the resident. After evaluation of the level of incontinence, the resident can then be enrolled. This article provides a practical toolkit for assessment of a resident in assisted living general or memory care populations in addition to the different types of programs a resident can enroll into after evaluation completed.

Time of Onset to Changes in Skin Condition During Exposure to Synthetic Urine: A Prospective Study.

PURPOSE: The purpose of this study was to evaluate the impact of incontinence on epithelial-moisture barrier function and the subsequent risk for incontinence-associated dermatitis by exposing healthy volunteers to a premium incontinence pad wet with synthetic urine. DESIGN: Prospective, single-group study. PARTICIPANTS AND SETTING: Thirty women 65 years or older participated in the study. Participants had healthy skin of the buttocks, perineal, and perigenital areas and were not incontinent of urine or stool. The study was conducted at a contracted clinical research facility in Southeastern United States. METHODS: Four hundred milliliters of synthetic urine was distributed across the width of a premium incontinence pad with wicking technology containing a superabsorbent polymer core. Participants laid supine for a total of 4 hours, with the wet pad under the buttocks. Skin assessments were conducted at baseline prior to contact with the wet pad, at 15 minutes, 30 minutes, and 1, 2, and 4 hours after exposure to the synthetic urine. Outcome measures were skin moisture content, cutaneous pH, transepidermal water loss (TEWL), mean coefficient of friction values (static and dynamic), and tolerability evaluations (expert clinical grader-assessed erythema and participant-assessed discomfort). RESULTS: Mean moisture content of the skin increased from 46.19 ± 22.1 to 1845.28 ± 542.7 micro-Siemens (µS) after just 15 minutes of exposure and was significantly increased at all time points compared to baseline (P < .001). Cutaneous pH increased from 5.67 ± 0.5 to 6.25 ± 0.1 after 15 minutes; pH was higher at all time points compared to baseline (P < .001). Passive transfer of water through the stratum corneum (TEWL) showed an increase from 9.02 ± 2.2 g/m/h at baseline to 16.83 ± 5.2 g/m/h at 4 hours (P < .001). There was a significant increase from baseline to 4 hours in mean coefficient of static friction (0.32 ± 0.01 vs 0.47 ± 0.03; P < .00001) as well as mean coefficient of dynamic friction (0.29 ± 0.01 vs 0.42 ± 0.02; P < .00001). There was a significant increase in erythema and an increase in participant-assessed discomfort at all time points (P < .005). CONCLUSIONS: Our findings suggest that impairment of the skin's epithelial-moisture barrier function associated with inflammation and development of incontinence-associated dermatitis begins rapidly after an incontinence event, even with the use of a premium pad with wicking technology. Study findings also suggest that prompt attention to incontinence events is needed to prevent moisture-associated skin damage (incontinence-associated dermatitis) even when absorbent pads are used.

A Novel Approach to Treating Moderate to Severe Incontinence-Associated Dermatitis and Intertriginous Dermatitis: A Case Series.

BACKGROUND: Patients with moderate to severe incontinence-associated dermatitis (IAD) and intertriginous dermatitis (ITD) often experience pain that negatively affects activities of daily living. While traditional treatments, such as skin protectants including ointment or cream-based products, cyanoacrylate-based monomers, and wicking agents, help some patients, those with moderate to severe cases require more aggressive treatments to accelerate healing. CASE SERIES: This article describes a series of 4 hospitalized patients who presented with moderate to severe IAD and/or ITD with and without fungal infections. These patients were treated with therapies that went beyond routine skin care regimens, which included treatment with a combination of 0.25% acetic acid, a topical steroid agent, or a topical antifungal when necessary. The patients included a 74-year-old woman admitted with hypovolemic shock, an 82-year-old obese woman with pulmonary hypertension and heart failure, an 80-year-old woman with medically complicated obesity, and a 54-year-old morbidly obese woman admitted with sepsis. CONCLUSION: The outcome achieved using this novel approach was successful in treating moderate to severe IAD and ITD in these cases.

Role of the Wound, Ostomy and Continence Nurse in Continence Care: 2018 Update.

The Wound, Ostomy and Continence Nurses Society believes the tri-specialty certified nurse (Certified Wound Ostomy Continence Nurse [CWOCN]) or advanced practice tri-specialty certified nurse (Certified Wound Ostomy Continence Nurse-Advanced Practice [CWOCN-AP]) possesses unique knowledge, expertise for assessment, and first-line management of incontinence as well as for prevention of incontinence. The CWOCN or CWOCN-AP provides care and consultation in the treatment of potential and actual skin complications through absorption, and containment, in persons with urinary, fecal, or dual incontinence. This executive summary describes the role of the CWOCN or CWOCN-AP in the delivery of continence care across care settings. The original statement is available at https://cdn.ymaws.com/www.wocn.org/resource/collection/6D79B935-1AA0-4791-886F-E361D29F152D/Role_of_Continence_Nurse__2018_.pdf.

Where Do Women With Urinary Incontinence Find Information About Absorbent Products and How Useful Do They Find It?

PURPOSE: This study aimed to determine from what sources women with urinary and dual urinary and fecal incontinence sought and received information about incontinence and absorbent products. We also evaluated source utility. DESIGN: Descriptive, embedded, mixed-methods study with qualitative interviews nested into a survey design in a modified explanatory sequence. SUBJECTS AND SETTING: The target population was community-dwelling women in Canada who used containment products to manage urinary incontinence. Three hundred fifteen women completed the online survey, and 9 participated in interviews. METHOD: Quantitative data were collected using an online survey that was advertised in multiple locations, including continence and urogynecology clinics, non-for-profit health Web sites, and social media. Descriptive statistics were used for analysis. Using initial quantitative data results, a semistructured interview guide was designed to gain further insight. Local survey participants were invited to interviews at the end of the survey. Interview transcripts were coded using content analysis. The codes were then collapsed into categories and finally themes. RESULTS: The most common sources of information (n = 284/315) were retail outlets (43%) and television/radio (42%). The greatest percentages of "useful" or "very useful" resources were healthcare professionals (83%). Content analysis identified 5 themes: (1) using existing knowledge, (2) seeking knowledge, (3) finding the right pad, (4) being safe and secure, and (5) perceptions of healthcare professionals' roles. Product choice was made through trial and error; women drew information from a variety of sources, including product labels. Perceptions of helpfulness of experiences with healthcare professionals varied. CONCLUSION: Although women used multiple sources when selecting containment products, they did not receive information in a manner that suited their needs, resulting in a trial-and-error approach to product selection. Healthcare professionals should actively give information on containment products during their assessment of continence in patient encounters.